heathervaught

Jane, your analyzers can't tell the difference between "live" and "dead" platelets - in its eyes, any particle that meets the criteria of looking like a platelet is a platelet. What we have noticed is that we get lower counts when platelets are stressed and have started to stick together (not visible to the naked eye, of course), then as they relax and become happy with their environment, they will become un-stuck, and the platelet count will be higher. We usually see the inverse of what you describe though...the platelet count is lower on samples taken shortly after collection, then higher after 24 hours of agitation, when the platelets have had time to adjust to life in a storage bag. Here's where I would start: have you checked out the implicated donors for your "weird" products? You may find that you have a couple of frequent donors who are causing the observed phenomenon. Does your Sysmex report MPV? Is it higher in the samples with lower platelet counts? This would be positive evidence of the "sticky" platelet theory.

Genotyping the baby using a buccal swab would probably provide the information that you are looking for. I would ask your Reference Lab if they have the capability to do that, and if not, I know of a few that can.

We have used the Temp Record data loggers for our temperature mapping and validations. I haven't heard of the other two.

If you want to shop around, I would suggest going to aabb.org or americasblood.org and searching as if you were a donor looking for somewhere to donate. Or, if you have been using NBE and notice that you are impressed with a few facilities, give them a call and see what it would take to set up some sort of contract.

I would discuss with your medical director and your supplier's medical director to come to a consensus. As a biological product, I expect some aggregation to occur over time. However, excessive, large, or persistent platelet clumps could be a sign of a process problem by the supplier. If your MD does decide to transfuse, then you can be assured that the administration set filter will trap the aggregates.

When we wash apheresis platelets for treatment of NAIT, we are often collecting a compatible unit from the mother for transfusion to a neonate. Half of the product is routinely washed and issued for transfusion upon collect, and the other half is held and used if/when the baby needs to be transfused again. The 2nd half is used for bacterial detection (unless it is needed prior to the 24-hour window). Our blood center MDs and the transfusing MDs are fine with the approx. 1.5 x 10^6 dose for a neonate. We have the same type of setup, mdcbk, our final volumes are approx 60-90 mL.

The bioMerieux BacT/ALERT 3D and Pall eBDS are both FDA-approved for bacterial detection of platelets.

If you are US AABB accredited facility, you are required to screen all platelet components for the presence of bacteria. There are a few ways to do it, but one of the methods is using a culture-based technique. There is some international suggestion of avoiding culture if you give your platelets a 3-day expiration.

Yes, we collect MCS+ 8150 and Cymbal RBCs and freeze them occasionally. We don't freeze much these days, though.

I have been looking for a reference...I have this statement in an e-mail, but I can't find it anywhere online. "Please see below for Q & A from ATAG meeting. Question: May historical RBC antigen phenotypes be listed on tie tags? FDA Response: No, historical RBC antigen phenotypes may not be included on the tie tag. The tie tag should only be used to include test results from the current donation. In addition, listing historical RBC antigen phenotypes on a tie tag is not consistent with the labeling regulations in 606.121©(12) and 606.121(j). Additionally, the blood bank must have a way to convey the historical RBC antigen phenotypes to the consignee."

We measure pH in an open system using an Oakton tabletop pH meter and a 1-mL sample that is dispensed into a test tube. These tests are not performed to detect bacterial contamination. The platelets should have a pH is above 6.2. We instruct our staff to perform the pH as soon as possible...but some unofficial testing has shown us that the pH value is actually stable over several hours.

I know that we have turned away donors who cannot safely get themselves into the donor couch. I don't know first-hand of anyone who has been turned away because of weight, but I do know of someone who we turned away because they were wheelchair bound and couldn't get themselves into the bed. Our donor center staff could not assist due to liability risk. We chose not to draw from the wheelchair for the donor's safety - if she had passed out, she could have fallen from the chair. Other reactions would have been harder to manage as well.

We collect platelets using the Trima device, and the sampling set is pre-attached to the platelet bag. They also sell them individually and can be sterile-docked onto a component. I do know if they are available where you are, but I have found and attached the Instructions for Use for the sampling set. [ATTACH]443[/ATTACH] Sampling Set IFU.pdf

Here is our process at a large blood center. It is similar to velliott's protocol. Products are collected on Day 0. They are divided into two bags, but remain connected. If the volume is over 600 mL, then we add a 3rd bag for the breathability issue that Liz mentioned. They are stored, agitating, overnight. On Day 1, when the product reaches 24 hours old, it is removed from the agitator. A 10-mL sample is collected. 8 mL is placed into an aerobic BacT/ALERT bottle, and 2 mL into an EDTA tube. The product is weighed, and our Testing laboratory is provided with the weight of the entire collection. At this point, our Component Lab also makes a judgement call based on product volume (since volume collected correlates to single, double, or triple targeted). If it potentially qualifies for a double or a triple, we equilibrate it within the 2 or 3 bags, then weigh each individual bag. While the BacT sample is incubating, the Testing laboratory does a platelet count using the EDTA tube, then multiplies the count times all of the weights provided. The product yields are reported to our Labeling department, and the Labeling associate will separate the bags if the product qualifies for a double or a triple.

We abandoned microhematocrit method and adopted HemoCue for all donors.

Per the AABB Technical Manual, 16th edition, page 619: "Microaggregate filters are not used for routine blood administration. These second generation filters were originally developed to remove leukocytes but have been replaced by more efficient third-generation leukocyte reduction filters. Microaggregate filters have a screen filter of 20 to 40 microns and retain fibrin strands and clumps of dead cells. Red cells, which are 8 microns in size, can flow through the filters. Microaggregate filters are typically used for the reinfusion of shed autologous blood collected during or after surgery." So...if you receive leukocyte reduced red cells, you should transfuse through a standard blood administration filter (170-260 microns). If you receive non-leukocyte reduced products, it is acceptable to transfuse through a leukocyte reduction filter...but prestorage leukocyte reduction is preferred.

Pull out your Standards and take a look - as I read it, if you validate it and maintain it, it is acceptable to use.

No - 5.8.4.2 talks about dedicated cytapheresis donors (i.e. granulocyte donors). 5.8.4.1 makes statements about allogeneic donors.

The only oral question that we ask is, "Have you read and understood all of the information given to you and have all of your questions been answered?"

We also notify our donors of situations where testing is not performed, and discard tubes if an incomplete donation is obtained. In the US, infectious disease testing is not considered a reward for donation, and donors are discouraged from donating for the sole purpose of being tested. These donors will receive the gift card or t-shirt AND reward points.

We define our reactions this way: ALL DONORS LIGHT: Pallor, sweating, nervousness, lightheadedness, hyperventilation, weakness, nausea, vomiting, itching/rash at phlebotomy site, tingling/numbness of fingers, muscle cramps (for apheresis donors) WHOLE BLOOD DONORS MODERATE: Fainting without injury, Irregular pulse, incontenence SEVERE: Fainting with injury, chest pain, cardiac arrest, involuntary movements APHERESIS DONORS (WB criteria also applies) MODERATE: facial flushing, abdominal cramping, perineal pain, chest pain, hypertension, involuntary movements SEVERE: Dyspnea/respiratory distress, hemolysis, chest or back pain, headache, anaphylaxis, and cardiac arrhythmia For all donors, a moderate reaction continuing 15 minutes or more is considered a Moderate reaction. A moderate reaction continuing 30 minutes or more is a sever reaction.

AABB Standard 5.8.4.1 states, "If, due to urgent need, blood or components are distributed or issued before completion of these tests, a notation that testing is not completed shall appear conspicuously on an attached label or tie tag. Required tests shall be completed and results reported ... as soon as possible."

I would check the Operator's Instructions for the storage devices that you are using. Many discourage bleach solution, but we will use it if a blood spill occurs. When a mild agent is required, we use a diluted Lysol solution.

I would refer to the Package Insert for the bottle that you are using. If they are like the bottles that we use for Platelet testing, they state something to the effect of, "On rare occasions, organisms may be encountered that grow in the BacT/ALERT culturebottle growth media but do not produce enough carbon dioxide to be determined positive." Also, "BacT/ALERT [positive] specimens may contain organisms that are not seen with routine smear methods and may require both specialized smears and subculturing media for detection and recovery." However, these incidents should be rare, and for both of them to occur simultaneously on multiple occasions is probably excessively improbable. I would get in touch with bioMerieux and see if they can help.

I don't know...the package inserts that I have seen for AHG state that the reading must be performed within 1 minute of adding the reagent or else you risk a false negative.